Category: Policy Updates

Why Don’t You Own Your Own Health Data?

David Brailer, MD, was the first head of the Office of the National Coordinator of Health Information Technology (ONC), appointed by President George W. Bush. Today, he is a venture capitalist.

In today’s Wall Street Journal, Dr. Brailer notes that a law passed in 1996 governs our access to health information. Clearly, it needs updating:

This brave new digital world has one huge risk: You don’t own your health information. In 1996 the U.S. passed a law called HIPAA (Health Insurance Portability and Accountability Act) requiring hospitals, physicians, labs, pharmacies and other “covered entities” as well as the health plans and their “business associates” (for example, an information-technology vendor) to protect how your data is stored and released. But not without delays, often for months. You can’t force a covered entity to give your data to someone you choose, and you can’t stop them from giving it to someone they choose. Health apps? Most aren’t covered by HIPAA at all, and can do whatever they want with your information.

It is a fascinating indictment by someone with unique expertise in the field. Dr. Brailer is demanding a substantial rewrite to current law. He is also deflating ONC’s assertions that it is succeeding in granting patients ownership of our health data.

I participated in a meeting in September 2013, in which Dr. Brailer’s charismatic and enthusiastic successor, Dr. Farzad Mostashari, repeatedly announced that he and his colleagues had (gulp) “created” – not even “discovered” or “defined” – a “new right” for patients to access our data. The notion that government agencies “create” rights should obviously be anathema in the United States.

However, another major obstacle to solving the problem Dr. Brailer identifies is that health insurers control most of our health spending. They also want to control our data. As long as this is the case, we patients will struggle to own our health data in any meaningful senses.

Only when patients directly control payment to providers will providers respect patients’ ownership of our own health data.

House & Senate Agree on Balanced Budget Resolution

The House and Senate Budget Committees have announced that their conference committee has agreed on a balanced budget resolution. The conference report is 106 pages, so it will take me a few days to complete an analysis.

Nevertheless, it is important to recognize that this is an important achievement and the result of a lot of hard work by Dr. Price, Senator Enzi, their colleagues and staff. For many years, the Senate ignored its legal obligation to pass a budget.

With respect to health care, the resolution repeals and replaces Obamacare in full. It also continues to increase Medicare premiums for high-income households, and transitions to Paul Ryan’s “premium support” model for future beneficiaries.

One of the items I had been hoping for is offsets to pay for the bungled Medicare “doc fix” of last month. The resolution states that it accounts for the full cost of that “doc fix” (page 45). Okay, but the current president will not sign this budget. Are we meant to expect that the next President will take responsibility for the unfunded spending authority this Congress gave President Obama?

One State Leads the Fight for Health Freedom

AZWhen it comes to no-holds-barred, patient-centered health reform, one state is absolutely crushing it: Arizona.

Governor Doug Ducey, a businessman with no direct healthcare experience, has recently signed (at least) three path breaking pieces of legislation.

We’ve already discussed Arizona’s law that will allow patients to order diagnostic tests without a physician’s order.

Federal Rules Create Big Obstacles for Health Information Technology Entrepreneurs

electronic-medical-recordThis blog has long noted the painful consequences of the federal government’s intervention in health information technology (HIT).  Last February, NCPA published an Issue Brief recommending that the federal government’s ambitions in HIT be rolled back. The major problem is the government’s undue influence in Electronic Health Records (EHRs).

Last month, the Administration published the regulations for stage 3 of the Meaningful Use incentives, which both pay and fine doctors for their use of EHRs in accordance with the rules. Margalit Gur-Arie describes the new rules:

Meaningful use stage 3 is adding a host of structured and codified data elements that you will need to collect and record. To that end, you should consider updating your policies as follows:

  • Require each patient to provide an updated resume at least once a year, because you need to continuously collect and update work history, including positions held, and financial information.
  • In collaboration with your attorney, create a crosswalk based on State laws and meaningful use regulations regarding what you must ask or are barred from asking your patients. For example, in some states you are not allowed to ask about guns in the domicile, and for meaningful use you must inquire how often your patient goes to church, and whether he or she is a homosexual (regardless of your specialty). It’s a fine balance, and you don’t want to break any laws.

Arizona: Blood Tests Without Physician’s Order

electronic-medical-recordGovernor Doug Ducey has signed a law that will allow patients to order lab tests directly from a lab, without physician intermediation. It will be self pay: No government nor private health plan has to pay for the tests.

The legislation was backed by one of the most exciting diagnostic companies in the market: Theranos, founded by an incredibly entrepreneurial young billionaire, Elizabeth Holmes. The firm’s technology allows a battery of tests to be run on a single drop of blood, instead of the long draws we are used to undergoing.

Ms. Holmes’ business strategy necessitates disrupting the very staid world of clinical laboratories, which has been protected from innovation by the government-driven payment model. Instead of lobbying to get inside the model, Ms. Holmes lobbied to be exempt from the model. We need more people like that in health care.

Patent Policy Cost India $10 Billion Investment

Variety of Medicine in Pill BottlesLegal support for intellectual-property rights is essential to innovation. In health care, patents protect intellectual property in pharmaceutical innovation. Not all countries respect pharma IP equally, according the Global IP Index.

India has long been a problem because of its successful generic drug industry. Generic drug makers make copies of brand-name drugs once their patents have expired. This means that they have an incentive to lobby for weaker patents. If the political economy of a country’s pharmaceutical industry is dominated by generic competitors, it is difficult for innovative companies to gain a foothold.

One Indian innovative drug maker is speaking out:

Hyderabad-based Hetero Pharma that the country has lost nearly $10 billion worth of investment by not respecting IP norms. “The Compulsory Licence (CL) that we issued did more harm to our image than actually helped patients,” Srinivas Reddy, director, Hetero Pharma, told ET. (Economic Times)

A compulsory license is one which the government orders a patent-holder to issue to a generic competitor at low-market fees. Let’s hope more Indian entrepreneurs speak out like Mr. Reddy has.

With Medicare Doc Fix, House Republicans Move Left of Obama on Health Reform

StethoscopeThe fallout from yesterday’s House vote to bind our children and grandchildren further into debt servitude to bail out an unreformed Medicare continues.

Before the vote, Chris Jacobs of America Next (Louisiana Governor Bobby Jindal’s think tank) warned that Medicare could not survive reform if the so-called “doc fix” passed. Writing after the unfortunate vote, Jacobs explains that House Republicans have actually moved left of Obama on Medigap reform:

The GOP’s Proposed Budgets’ Effect on Medicare and Medicaid

Today’s appalling vote in favor of a so-called Medicare doc fix that will increase the deficit by $141 billion makes it hard to take the House and Senate budget resolutions seriously. Nevertheless, they have a lot of positive reform in them. Sean Parnell of the Heartland Institute interviewed me for the Heartland Institute’s podcast.

The interview happened a few days ago, before we knew that almost all House Republicans were about to vote to endorse Obamacare’s vision of controlling Medicare by federalizing the practice of medicine. Nevertheless, if the Republicans ever re-gather their bearings. maybe they will move their budget forward.

Hear the entire podcast here.

What VA Scandal?

Senior Man ThinkingIn 2011, economist Paul Krugman attacked Republican lawmakers for wanting to reform the federal agency responsible for delivering health services to our military personnel. Krugman wrote, “Multiple surveys have found the V.H.A. providing better care than most Americans receive,” and said the VA was “a huge policy success story.” Well, he was wrong.

Today, we know the embattled agency needs an overhaul. When news broke last year that numerous veterans had died while awaiting medical treatment, the public was emphatic in its determination to deliver a message of discontentment to the VA. So, despite Krugman’s fanfare for the VA and despite the media ignoring the ongoing issues, a new report by Heartland Institute indicates at least one national veterans’ organization is still paying attention and thinks reform is necessary.

Republicans Plant Their Flags on Health Reform

U.S. Senator Ted Cruz declaring his presidential candidacy at Liberty University (March 23): “Imagine health care reform that keeps government out of the way between you and your doctor and that makes health insurance personal and portable and affordable.”

House Budget Committee’s budget resolution (March 17): “Individuals should be able to own their insurance and have it follow them in and out of jobs throughout their career.”

Senate Budget Committee’s budget resolution (March 18): “By adopting this new budget, Republicans can repeal the President’s health law and the committees of jurisdiction can continue to work on plans to replace it.”

These statements are all good news for reformers.